Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 44073 | WI |
NPI | 1003873548 |
---|---|
Provider Name | Dr. Carl J Peluso |
First Address | Brookfield, WI 53005-4423 |
Second Address | Brookfield, WI 53005-4423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 08/07/2007 |